Pregnancy, Childbirth and Work Support Tool Startpress Enter Is this your first child? * Yes No Do you have pre-existing health conditions, e.g. diabetes, hypertension, epilepsy, heart conditions etc… * Yes No Have you been to all your antenatal / pregnancy related appointments, scans, tests, medical appointments as required? * Yes No Are you experiencing any pregnancy related symptoms that are affecting your work, for example, nausea and vomiting (morning sickness), urinary tract infections, anaemia, fatigue and discomfort? * Yes No Are you 4 – 12 weeks pregnant? * Yes No Are you 13 – 24 weeks pregnant? * Yes No Are you 24 – 40 weeks pregnant? * Yes No Do you have any concerns about work or your working environment? * Yes No As part of your everyday work activity, do you: Carry out repetitive tasks? * Yes No Spend long periods standing? * Yes No Sit for long periods in one position? * Yes No Enter or work within confined spaces? * Yes No Carry out manual handling? * Yes No Have regular or potential exposure to whole body vibration? * Yes No Have regular or potential exposure to high levels of noise? * Yes No Work with or are potentially exposed to ionising radiation or radioactive materials? * Yes No Wear compressed air or air fed breathing apparatus? * Yes No Work with or have potential exposure to hazardous substances? * Yes No Is there the potential for exposure to high levels of carbon monoxide? * Yes No Is there the potential for exposure to heavy metals? * Yes No Do you wear PPE (Personal Protective Equipment) as part of your work activity? * Yes No Work long hours? * Yes No Work shifts? * Yes No Work nights? * Yes No Work in extreme cold or heat? * Yes No Work alone? * Yes No Work at height? * Yes No Have exposure to high levels of stress? * Yes No Do you work with display screen equipment (DSE)? * Yes No Is your workstation comfortable? * Yes No Do you take regular breaks from DSE work? * Yes No Do you travel to other sites or businesses? * Yes No Does your travel involve flying? * Yes No Does your travel involve extended periods of driving? * Yes No At work is there: A place to rest (and express breast milk) that is private and comfortable? * Yes No Access to clean drinking water? * Yes No Adequate facilities for expressing breast milk, washing, sterilising and storing receptacles (including a clean refrigerator)? * Yes No Easy access to clean and hygienic toilet and washing facilities? * Yes No Are they clean and hygienic? * Yes No Submit If you are human, leave this field blank. ContinueSubmit Use Shift+Tab to go back